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Year 2021 / Volume 28 / Number 4

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Review

Dorsal root ganlion pulsed radiofrequency for lumbosacral radicular pain: a narrative review

Rev. Soc. Esp. Dolor. 2021; 28(4): 219-231 / DOI: 10.20986/resed.2021.3882/2021

Pablo Jorge Castromán, Marta Surbano

ABSTRACT

Objective: Pulsed radiofrequency can be a nondestructive option compared with the thermical lesion produced by continuous radiofrequency. The application of PRF of the dorsal root ganglion is a therapeutic tool in patients with Lumbosacral Radicular Syndrome refractory to epidural steroids injections. The mechanisms of action are not clear yet and a neuromodulation process is proposed. The evidence of the efficacy of this intervention is of low quality, due to several factors. Our objective is to present a review of the evidence of the efficacy and safety profile of the DRG RFP. The clinical aspects related to the technique and its possible mechanisms of action are also reviewed.
Material and methods: A bibliographic review was performed in MEDLINE (Pubmed), Google Scholar, Scopus, CINAHL, Embase, Cochrane and Fisterra (clinical guidelines) of articles in English and Spanish, during the available years with the terms: “Dorsal Root Ganglion pulsed radiofrequency” and “lumbar” or “lumbosacral radicular pain” in English and Spanish. Bibliographic review was carried out by the 2 authors independently.
Results: We present the analysis of eight prospective, randomized studies and nine cohort studies, with a before and after type of design, in which the study of efficacy and safety was proposed as the main objective.
Conclusions: This review suggested that PRF of the DRG can be a good therapeutic option in patients with refractory LRS. Larger, blinded, prospective and randomized controlled trials are needed to support this statement.

RESUMEN

Objetivo: La radiofrecuencia pulsada constituye la variante no destructiva de la termolesión por radiofrecuencia. Una opción terapéutica en pacientes con síndrome radicular lumbosacro refractario a esteroides epidurales es la aplicación de RFP en el ganglio de la raíz dorsal. Si bien el mecanismo íntimo de acción de la misma no está del todo esclarecido, se plantea como una técnica de neuromodulación. La evidencia de la eficacia de esta intervención es débil por diversos factores: insuficientes estudios clínicos randomizados, el bajo tamaño muestral utilizado en los mismos, las controversias sobre algunos aspectos técnicos en la aplicación de la RFP, la selección incorrecta de pacientes, la presencia o no de dolor neuropático, etc. Nuestro objetivo es presentar una revisión de la evidencia de la eficacia y el perfil de seguridad de la RFP del GRD en pacientes con SRLS refractario. Los aspectos clínicos relacionados con la técnica y sus posibles mecanismos de acción son también reseñados.
Material y métodos: Realizamos una búsqueda bibliográfica en MEDLINE (Pubmed), Google Scholar, Scopus, CINAHL, Embase, Cochrane y Fisterra (guías clínicas) en inglés y español para todos los años disponibles con los términos “Dorsal Root Ganglion pulsed radiofrequency” y “lumbar” o “lumbosacral radicular pain” en idioma inglés y español. La evaluación fue realizada por los dos autores de manera independiente.
Resultados: Presentamos el análisis de ocho estudios prospectivos randomizados y nueve de cohorte única de tipo antes y después, de pacientes con dolor radicular lumbosacro refractario cuyos objetivos fueron la evaluación de la eficacia y seguridad de la técnica.
Conclusiones: La RFP del GRD podría ser una opción terapéutica útil en el SRLS refractario, pudiendo considerarse sus resultados como preliminares, y deberán ser confirmados por estudios prospectivos randomizados con criterios de selección homogéneos y mayor número de pacientes.

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Tablas y Figuras

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Table I

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Instrucciones para citar

Castromán P, Surbano M. Dorsal root ganlion pulsed radiofrequency for lumbosacral radicular pain: a narrative review. Rev Soc Esp Dolor 2021; 28(4): 219-231 / DOI: 1020986/resed20213882/2021

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Recibido: 02/01/2021

Aceptado: 18/09/2021

Prepublicado: 23/09/2021

Publicado: 15/10/2021

Tiempo de revisión del artículo: 216 días

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